Researchers get deadly with hepatitis intervention

A hepatitis C intervention program in Western Sydney could be rolled out across the state following a funding boost from the Federal Government.

UNSW's Centre for Social Research in Health (CSRH) has been awarded an $848,000 partnership grant by the National Health and Medical Research Council (NHMRC) to evaluate an innovative hepatitis intervention project for Aboriginal and Torres Strait Islander people called Deadly Liver Mob, which has been operating in Mt Druitt for three years and in Penrith for about 18 months.

Led by CSRH Director Professor Carla Treloar, the four-year study will evaluate the health outcomes and impact of Deadly Liver Mob, examine its acceptability and establish a translational framework that would enable DLM to be scaled up across NSW and even further afield.

The study “Deadly Liver Mob: Engaging Aboriginal people in viral hepatitis, HIV and sexual health services” has attracted $1.5 million in cash and in-kind contributions from partners including the NSW Ministry of Health, Local Health Districts and the North Coast Public Health Unit.

Professor Treloar says the research will lead to better health outcomes for Aboriginal people and provide evidence to shape policy, health care delivery and surveillance of sexually-transmitted infections and hepatitis among Aboriginal people.

Rates of sexually transmissible infections and blood-borne viruses such as hepatitis are disproportionately high among Indigenous people but more traditional methods of hepatitis education have had low success in engaging Aboriginal communities.

Professor Carla Treloar says the research will lead to better health outcomes for Aboriginal people and provide evidence to shape policy and health care delivery. Picture: Dan White

An initiative of the Harm Minimisation teams of Western Sydney and Nepean Blue Mountains Local Health Districts, Deadly Liver Mob is a peer-driven incentive-based program that offers education and screening for blood-borne viruses and sexually transmissible infections. It focuses on existing clients and seeks to engage with their networks, increasing people’s access to services.

Delivered by Aboriginal health workers, the program offers shopping vouchers as incentives for participants to be educated about blood-borne viruses, to consider hepatitis C and sexual health screening, and to recruit and educate their peers. Clients receive a $20 supermarket voucher when they participate in the initial education and can claim additional vouchers on subsequent visits.

Professor Treloar acknowledges that the shopping vouchers might be contentious but says they have resulted in much wider networks of people attending hepatitis education, testing and counselling, including several generations of family members.

“The incentives are interesting but it’s a really modest investment for a very large impact,” she says. “And being able to say we value you turning up is an important thing.”

The CSRH, part of the Faculty of Arts & Social Sciences, previously received funding from NSW Health to do some limited evaluations of Deadly Liver Mob, which Professor Treloar says has been very positively endorsed by the community.

In its first 12 months, the project engaged more than 400 Aboriginal people in a hepatitis health promotion activity, with subsequent referral of more than 300 people to sexual health screening and a 1023% per annum increase in access in sexual health services.

Traditional methods of hepatitis education have had low success in engaging Aboriginal communities.

Professor Treloar says that while the preliminary outcomes are exciting, the overall impact and acceptability of the program requires further investigation. Her team will investigate whether DLM can be scaled up and implemented as standard practice across the state and possibly across the country.

“There are differences in how the two centres have been able to operate in terms of needs, complexities and variables,” she says. “It’s more difficult when you’re working with different communities, looking at different health needs, so we need to be able to look at the real world and decide how we best tackle a complex problem for a community that has a special place in health care delivery.”

The researchers will look at clinic data to assess if there has been an increase in the number of Aboriginal people attending, and whether they come back. “We’ll also do work with the service staff to find out what works, what they had to do in the local site to make it work, and what kind of trouble shooting they needed to do to ensure it ran smoothly,” Professor Treloar says. “There are lessons to be learned on how to modify the program, how to roll it out elsewhere and how to support the people who are part of it.”

The employment of Aboriginal project workers has been essential to the credibility of and trust in the program, Professor Treloar says. “The key to making it work is to have Aboriginal people there to greet people when they come to the service and to introduce it, not to mention having their expertise on how to work with the community,” she says. “In communities where more traditional medical services may be regarded with suspicion, that’s really important.”

Hear Professor Carla Treloar and Professor Greg Dore, head of the Viral Hepatitis Clinical Research Program at the Kirby Institute at UNSW, discuss groundbreaking new treatments for hepatitis C in a World Hepatitis Day episode of the new podcast SpeakEasy.